Plastic Surgeon Dr. Dean Kane of Baltimore Answers Question Regarding

Photo courtesy of RealSelf.com NOT a Center for Cosmetic Surgery & Medi-Spa Patient

Q: Has anyone seen this type of infection after facelift? I’ve been quite active on this site throughout my facelift recovery since having my surgery 12 weeks ago, but have yet to post. I’ve uploaded a picture from 4 days after surgery of an infection that developed and took weeks to heal. My question to the community is has anyone else had or seen this type of skin infection? I have not been able to find anyone. 12 weeks post it’s healed, however has left behind a couple of raised scars. My PS is working hard to make sure that all looks great in this end.

A: So sorry for your troubles! Thanks for sharing this photo. To recap, you are now 12 weeks following facelift but the photo is 4 days following facelift.

The skin is nourished by microscopic and visible blood vessels entering parallel to and vertical to the skin. The incision along the ear looks well done but by definition of surgery separates circulation from the ear side vessels. In addition, the cheek skin is lifted and separated off the complex vertical vessels which percolate up into the skin; this is called a skin flap.

With reduced circulation, the edge and the skin flap closest to the edge have the least amount of blood flow. When tissue loss is imminent, this is called ischemia and the body reacts with maximally opening the vessels and the heart pumping more blood flow.

When tissues are well nourished, the normal colonization of skin bacteria is held in check by the immune system but with added stress of ischemia, the micro-environment will allow yeast and bacteria (staph and strep) in your case to flourish. Patients who are compromised by background medical problems like diabetes, liver disease, high blood pressure, dehydration, tobacco / vapor, radiation use and other medical and environmental factors have more problems healing and also have more potential for such infection. While this is uncommon in the face, it is not rare.

Recommendations to assist in the reversal of ischemic flaps may include the use of:

Complete abstinence of primary or secondary smoke or tobacco products and any other medications or drinks that include caffeine or other vasoconstrictor products.

Nitroglycerin paste or NitroDur patches

Warmth by rubbing your hands and cupping them over the flap site (a warming blanket / hot water bottle or compresses may burn the skin as it is already compromised. Cool or cold compresses could “frostbite” the skin flap as it already has poor circulation.

Hydration by drinking water with or without electrolytes. No sugary or caffeinated drinks which dehydrate.

Light walking to increase the pumping action of the heart.

Head elevation to reduce congestion

Steroid medication to assist in vasodilation and congestion

Consideration for hyperbaric oxygen therapy for improved oxygen penetration of the skin

Recommendations to assist in reversal of infections may include the use of:

Once healed, there are various options to improve the texture, color and scar appearance which may include:

Retinoids: tretinoin, retinol for skin regulation and scar remodeling

Hydroquinone for even pigmentation

Steroid cream or injection

Peels, IPL and Laser

Silicone Gel Sheeting

Massage

Vitamin and mineral supplementation

It sounds like you and your Surgeon responded quickly to these changes and the tissue compromise was minimal. I trust that with proper time (more than a year) and continued care, you will have both your desired facelift results and minimized additional scarring or texture changes. Please share these with us! I wish you the best!

This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.

Give us a call at 410.602.3322 or email Lauri@DrDeanKane.com and make an appointment soon. We’re located on Reservoir Circle just a block off the Baltimore beltway, convenient to greater Baltimore, Annapolis, the Eastern Shore, Southern Pennsylvania, Delaware and Frederick.

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